The term “permanent” refers to a physical, mental, or emotional impairment which can be substantiated by medical findings. The impairment must be of major importance not likely to improve, or which will continue throughout the lifetime of the person, or to respond to any known treatment and is likely to remain static or become worse unless certain therapeutic measures are provided except when treatment is inadvisable, unavailable, or the person refuses treatment and his decision is reasonable. (A refusal of treatment is considered reasonable when the treatment recommended to prevent the progress of the condition is genuinely feared as to the outcome of the treatment, or when the person has religious scruples.)

The term “totally” refers to the ability of the person to carry out those activities necessary to performing specific employment responsibilities or homemaking. Totally involves consideration of age, training, skills, work experience, and the functioning of the person in light of his impairment.

It takes into consideration the activities required of a person in his job, at home his living and working conditions, interests, native capacities, and the extent to which he has adjusted to the loss he has sustained. The concept also includes an assessment of the person's attitudes, reactions, personality traits and motivations. No time factor is involved in the concept of being totally disabled.

A person's employment history should identify not only the specific industry he has worked in but also the job content. It should include a description of the kind of activities required—standing, sitting, dexterity; also his regularity of attendance, reliability, length of time on the job, and dates of last employment. Such information will help SMRT members to relate medical findings to the types of activity the individual is competent to perform.

The term “useful occupation” refers to those productive activities which add to the economic wealth, or produce goods or services to which the public attaches a money value. Certain activities in which invalids and other seriously incapacitated individuals sometimes engage in are not useful occupations for the purpose of this program. Usually these activities include hobbies, activities which do not provide a bona fide job opportunity, i.e., if the individual stopped doing it no one would be hired to replace him. Under the above interpretation, individuals may engage in activity which is part of a training program in their own homes, in schools, sheltered workshops, factories or other places offering opportunity for such training. The determining factor is not location but the presence or absence of supervision and of a training objective, as well as the economic value of what is produced. Thus some persons working in a sheltered workshop may be found to be engaging in a “useful occupation,” but others will not be so engaged since their activities are part of a rehabilitation plan and are not currently of economic significance.

Remuneration which may be received through useful activity of less than full time or unpredictable stability need not necessarily contravene a finding of total and permanent disability. Such earnings must be considered in determination of the eligibility factor of need, along with total income from all other sources. Some persons, because of extremely strong drive or motivation may push themselves beyond advisable physical limits. Social workers should be alert to such situations and clarify with the treating physicians whether the client's activities may exceed his actual physical limitation.